Provider Demographics
NPI:1730175407
Name:MCCRACKEN, COLE (MA, PSYD)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15779-0111
Mailing Address - Country:US
Mailing Address - Phone:724-675-2013
Mailing Address - Fax:
Practice Address - Street 1:121 LONGVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779
Practice Address - Country:US
Practice Address - Phone:724-675-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical